Scientists assess home visiting programs in Midwest

Can reaching out to new mothers right at the outset of parenting set them on the right path? A new study published in BMC Health Services Research assesses home health visitation programs, which provide perinatal mental health services for mothers and families who might not otherwise have access to such resources.

The study details a community-engaged formative evaluation designed to scale the “Mothers and Babies” cognitive-behavioral intervention within state home visiting programs across Iowa and Indiana. The investigation was led by Elissa Z. Faro, Ph.D., an implementation scientist and medical anthropologist at the Hackensack Meridian Center for Discovery and Innovation (CDI), alongside co-principal investigator Kelli Ryckman, Ph.D., associate dean of research at Indiana University School of Public Health—Bloomington.

Perinatal depression and anxiety are common and potentially serious complications of pregnancy and childbirth, directly contributing to maternal mortality and persistent health disparities, particularly among Black, Indigenous and people of color (BIPOC) populations.

Home visiting programs (HVPs) are a vital community health link already reaching thousands of low-income and marginalized families annually. But delivering evidence-based mental health interventions from these HVPs—which vary in operations, staffing and funding—poses implementation challenges.

The researchers consequently launched a multifaceted investigation as part of IMPACT (Implementing Mental Health Programs Across Communities in Iowa & Indiana) trial. Using a modified Implementation Mapping approach, the team partnered with health care providers, state agency representatives and program recipients to adapt an implementation facilitation strategy.

The researchers mapped more than 500 programs across Indiana and Iowa. A survey of 72 of these HVPs demonstrated that over 90% of responding programs routinely screen for perinatal depression—further emphasizing the need for structured, evidence-based intervention tools during home visits.

Interviews with participants reached in the program identified key engagement barriers, including fear of judgment and scheduling logistics, as well as the importance of involving broader social networks and family connections.

In-person meetings held in Des Moines and Indianapolis brought together home visitors, supervisors, program directors, social workers and state health department officials to understand and prioritize social determinant factors in outreach.

Virtual panel meetings conducted in English and Spanish further connected the outreach to the groups.

The formative evaluation revealed key differences in state priorities: Indiana emphasized logistical challenges such as staff workload and integration into existing workflows, while Iowa participants homed in on the importance of communication systems, training infrastructure and mental health consultations.

Altogether, the research group produced the IMPACT Implementation Support Package, structured around four core performance outcomes: professional development and staff growth through ongoing skill development, integration into the implementation system, better staff understanding of mental health, and the ongoing building of trust and rapport among clients and client groups.

These findings emphasize the need to reach out to mothers who need a helping hand—and ear—at a critical start of their parenting experience.

“The findings from this study carry important implications for health service delivery and policy,” the authors write.

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